How do Wellbutrin (bupropion) and Strattera (atomoxetine) compare for treating Attention Deficit Hyperactivity Disorder (ADHD)?

Comparison of Wellbutrin and Strattera for ADHD Treatment

Strattera (atomoxetine) is more effective than Wellbutrin (bupropion) for ADHD treatment, with stronger evidence supporting its use as a first-line non-stimulant option for ADHD. 1

Mechanism of Action

Strattera (Atomoxetine)

• Selective norepinephrine reuptake inhibitor that specifically targets the presynaptic norepinephrine transporter 2, 3
• High affinity and selectivity for norepinephrine transporters with minimal affinity for other neurotransmitter receptors 2
• Preferentially binds to areas with high distribution of noradrenergic neurons, particularly in the fronto-cortical subsystem 3

Wellbutrin (Bupropion)

• Aminoketone antidepressant that acts as a non-competitive antagonist of nicotinic acetylcholine receptors 4
• Inhibits reuptake of dopamine and norepinephrine
• Originally approved for depression and smoking cessation, used off-label for ADHD 4

Efficacy

Strattera (Atomoxetine)

• FDA-approved specifically for ADHD treatment in both children and adults 1, 5
• Demonstrated efficacy in multiple randomized, double-blind, placebo-controlled trials 2, 3
• Produces significant improvements in ADHD Rating Scale scores compared to placebo 3, 6
• Recommended starting dose: 0.5 mg/kg/day; target dose: 1.2 mg/kg/day 1
• Can be administered once daily or split into two doses 3, 6

Wellbutrin (Bupropion)

• Used off-label for ADHD 4
• Low-quality evidence showing moderate efficacy in reducing ADHD symptoms 4
• Recommended starting dose: 100-150 mg daily (sustained-release) or 37.5 mg every morning; target dose: 150 mg twice daily 1
• May be an alternative when stimulants and other non-stimulants are not effective or tolerated 4

Clinical Considerations

When to Choose Strattera

• First-line non-stimulant option for ADHD 1
• Particularly useful for patients with:
  • Substance use disorders (negligible abuse potential) 5, 6
  • Comorbid anxiety or tics 1
  • Need for once-daily dosing 3
  • Patients who prefer not to take controlled substances 5, 6

When to Consider Wellbutrin

• Alternative when other ADHD medications have failed 4
• May be beneficial in patients with comorbid depression 1, 4
• Option for patients who cannot tolerate Strattera's side effects

Side Effects

Strattera (Atomoxetine)

• Common side effects: headache, abdominal pain, decreased appetite, nausea, somnolence 3
• May cause slight increases in heart rate and blood pressure 3
• Black box warning for suicidal ideation 3
• Rare risk of serious liver injury 3

Wellbutrin (Bupropion)

• Common side effects: dry mouth, insomnia, headache, nausea 4
• Rare but serious risk: seizures (particularly at higher doses) 7
• Possible risk of cardiovascular malformations (relevant for pregnancy) 7

Practical Application

For optimal outcomes:

1. Start with Strattera as the first-line non-stimulant option for ADHD
2. Initial dose: 0.5 mg/kg/day, titrating to 1.2 mg/kg/day 1
3. Allow 2-4 weeks for full therapeutic effect
4. Consider Wellbutrin as an alternative if:
   • Strattera is ineffective or poorly tolerated
   • Patient has comorbid depression that would benefit from bupropion
   • Starting dose: 100-150 mg daily (sustained-release) 1

Monitoring

• Regular assessment of ADHD symptoms using standardized scales
• Monitor blood pressure, heart rate, and other side effects at each visit
• Schedule follow-up within 2-4 weeks after medication initiation 1
• Assess for suicidal ideation, particularly when initiating therapy 1

Both medications have negligible abuse potential compared to stimulants, making them valuable options for patients with substance use concerns or those who prefer not to take controlled substances 5, 6.